THE LEGISLATURE

Andy Gardiner Steve Crisafulli President of the Senate Speaker of the House of Representatives

June 16, 2015

The Honorable Andy Gardiner President of the Senate

The Honorable Steve Crisafulli Speaker, House of Representatives

Dear Mr. President and Mr. Speaker:

Your Conference Committee on the disagreeing votes of the two houses on SB 2508-A, same being:

An act relating to Medicaid.

having met, and after full and free conference, do recommend to their respective houses as follows:

1. That the House of Representatives recede from its Amendment 297529. 2. That the Senate and House of Representatives adopt the Conference Committee Amendment attached hereto, and by reference made a part of this report.

The Honorable Andy Gardiner The Honorable Steve Crisafulli June 16, 2015 Page 2

Conferees on the part of the Senate

Senator Tom Lee, Chair Senator Lizbeth Benacquisto, Vice Chair

Senator Senator

Senator Senator Rob Bradley

Senator Senator II

Senator Dwight Bullard Senator Jeff Clemens

Senator Charles S. Dean Senator Nancy C. Detert

Senator Miguel Diaz de la Portilla Senator Greg Evers

Senator Anitere Flores, At Large Senator Don Gaetz

Senator Bill Galvano, At Large Senator Rene Garcia

Senator Senator Denise Grimsley, At Large

Senator Alan Hays Senator Dorothy L. Hukill

Senator Senator Arthenia L. Joyner, At Large

Senator Senator John Legg

Senator Gwen Margolis, At Large Senator Bill Montford

Senator Joe Negron Senator Garrett Richter, At Large

Senator Jeremy Ring Senator Maria Lorts Sachs

Senator David Simmons, At Large Senator

Senator Christopher L. Smith, At Large Senator Eleanor Sobel

SB 2508-A The Honorable Andy Gardiner The Honorable Steve Crisafulli June 16, 2015 Page 3

Senator Darren Soto Senator

Senator Geraldine F. Thompson

SB 2508-A The Honorable Andy Gardiner The Honorable Steve Crisafulli June 16, 2015 Page 4

Managers on the part of the House of Representatives

Representative Richard Corcoran, Chair Representative , Vice Chair

Representative , Chair Representative , At Large

Representative Representative Jason T. Brodeur

Representative Matt Caldwell, At Large Representative Gwyndolen Clarke-Reed, At Large

Representative Representative W.

Representative Jose Felix Diaz, At Large Representative Eric Eisnaugle, At Large

Representative Representative , At Large

Representative Matt Gaetz, At Large Representative , At Large

Representative Gayle B. Harrell Representative Clay Ingram, At Large

Representative Mia L. Jones, At Large Representative MaryLynn Magar

Representative Charles McBurney, At Large Representative Larry Metz, At Large

Representative Amanda Murphy Representative Jeanette M. Nuñez, At Large

Representative Jose R. Oliva, At Large Representative H. Marlene O'Toole, At Large

SB 2508-A The Honorable Andy Gardiner The Honorable Steve Crisafulli June 16, 2015 Page 5

Representative Mark S. Pafford, At Large Representative Cary Pigman

Representative Elizabeth W. Porter, At Large Representative Holly Raschein, At Large

Representative Paul Renner Representative David Richardson

Representative Darryl Ervin Rouson, At Large Representative Cynthia A. Stafford, At Large

Representative Representative Alan B. Williams, At Large

Representative John Wood, At Large Representative Dana D. Young, At Large

SB 2508-A SUMMARY OF CONFERENCE COMMITTEE ACTION Page 1 June 16, 2015 The Conference Committee Amendment for SB 2508-A, relating to Medicaid, provides for the following:

 Redefines the definition of “rural hospital” to remove the provision that hospitals qualifying as sole community hospitals under federal guidelines are automatically qualified as rural hospitals under Florida law if they have no more than 340 beds.  Authorizes the Agency for Health Care Administration (AHCA) to receive intergovernmental transfers (IGTs) of funds from local governmental entities for the advancement of the Medicaid program. Directs AHCA to seek federal waiver authority to maintain a low-income pool under parameters provided in the General Appropriations Act for offsetting shortfalls in Medicaid reimbursement or paying for otherwise uncompensated care.  Confirms and clarifies existing law regarding reimbursement provisions, provider notification requirements, and the administrative challenge process for Medicaid inpatient and outpatient hospital rates. Specifies that the written notice of the hospital reimbursement rates provided by AHCA constitutes final agency action for purposes of administrative challenges to the hospital reimbursement rates.  Reenacts three statutory provisions for the purpose of incorporating the bill’s clarifications to reimbursement provisions, provider notification requirements, and the administrative challenge process for Medicaid inpatient and outpatient hospital rates.  Removes community intermediate care facilities for the developmentally disabled from the list of providers for which AHCA is required to set rates at levels that ensure no increase in statewide expenditures resulting from changes in unit costs.  Provides that quality assessments paid by nursing homes to AHCA are due on the 20th of each month, instead of the 15th of each month as under current law.  Creates the Graduate Medical Education Startup Bonus Program within the Statewide Medicaid Residency Program (SMRP). In any fiscal year in which funds are appropriated for the startup bonus program, hospitals eligible to participate in the SMRP may apply for up to $100,000 per newly created residency slot that is dedicated to a physician specialty in statewide supply/demand deficit. Such physician specialties and subspecialties are those identified in the General Appropriations Act.  Amends statutes relating to the Disproportionate Share Hospital (DSH) program and requires AHCA to use the average of the 2007, 2008, and 2009 audited disproportionate share data to determine each hospital’s Medicaid days and charity care for the 2015-2016 fiscal year, instead of the average of the 2005, 2006, and 2007 data as under current law.  Amends the Statewide Medicaid Managed Care program to: o Provide that achieved savings rebates that are refunded to the state by Medicaid managed care plans will be placed in the General Revenue Fund, unallocated; o Provide that funds contributed by managed care plans for the purpose of supporting Medicaid indigent care will be deposited into the Grants and Donations Trust Fund; o Provide that when payments from AHCA to managed care plans within the Long- Term Care Managed Care (LTCMC) component are reconciled to reimburse plans

SUMMARY OF CONFERENCE COMMITTEE ACTION (continued) Page 2

for actual payments to nursing facilities, the reconciliations must result from changes in nursing home per diem rates and that payments may not be reconciled to actual nursing home bed-days experienced by the LTCMC plans; and o Repeal s. 409.97, F.S., relating to state and local Medicaid partnerships.  Deletes a statutory provision requiring AHCA to use certified public expenditures of general revenue appropriated for Healthy Start services, including any associated federal match, for the purpose of supporting AHCA’s contract with an administrative services organization representing all Healthy Start coalitions.  Provides that AHCA may partner with a state or territory for the purpose of providing Medicaid fiscal agent operations only if Florida may terminate such a partnership if the state decides it is not in the best interest of the state.  Provides that the model, methodology, and framework for hospital funding programs contained in the document titled “Medicaid Hospital Funding Programs,” dated June 16, 2015, are incorporated by reference for the purpose of displaying, demonstrating, and explaining the calculations used by the Legislature when making appropriations in the General Appropriations Act for the 2015-2016 fiscal year for various Medicaid programs. Provides Legislative intent regarding the appropriations for various Medicaid programs and provides for the bill to be deemed invalid, non-severable, and to have never become law under specified conditions.

SB 2508-A